IMWG consensus statement on the role of vertebral augmentation in multiple myeloma

04.06.10

International Myeloma Working Group (IMWG) consensus statement on the role of vertebral augmentation in multiple myeloma1

Following are the recommendations of the IMWG on role of minimally invasive percutaneous injection of polymethyl methacrylate (PMMA), first developed as “vertebroplasty” in France in the late 1980s, as treatment for painful vertebral compression fractures (VCFs).

Consequences of VCF-related kyphosis

Compression of abdominal contents

Anorexia, weight loss

Decreased lung capacity

Limited exercise tolerance/physical activity

Anterior loading of spine

Subsequent fractures

Increasing kyphosis and deformity

Types of vertebral augmentation

Vertebroplasty: fractured bone fragments are stabilized and strengthened by percutaneous injection of PMMA.

Kyphoplasty: inflation of a balloon in the vertebral body prior to PMMA injection can restore vertebral height and reduce kyphotic deformity in addition to stabilizing the fractured vertebral body.

Indications for vertebral augmentation

Primary: severe pain present (pain >7/10 on Visual Analogue Scale)

Collapse of one or more vertebra (VCF)

Bone destruction (osteolytic/osteopenic) with high risk of collapse of one or more vertebra

Secondary: severe pain absent (pain </= 7/10 on VAS)

Significant loss of height and/or structural integrity or stability

Contraindications to vertebral augmentation

Absolute

Contraindications to general or local anesthesia

Pregnancy

Bleeding disorder

Infection at the site

Pain unrelated to vertebral collapse

Cord compression

Presence of overt instability

Severe cardiopulmonary insufficiency

Allergy to procedure-related drugs/contrast

Relative

Lesions above T3

Osteoblastic metastases

Patient < 40 years of age

Technically not feasible (vertebra plana)

Fractures with obstructing plasmacytoma

Retropulsed bone

Identification of patients suitable for vertebral augmentation

Careful assessment to determine source/severity of pain

MRI is essential to document the anatomy and assess spinal cord edema/compression.

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